| NPI | 1831594183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 19507) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN RN0000176501) |
| Enumeration Date | 2014-10-29 |
| Last Update Date | 2015-02-02 |