| NPI | 1831456177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN apn 16754) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN 161854) |
| Enumeration Date | 2012-04-11 |
| Last Update Date | 2013-04-10 |