| NPI | 1861881468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 104288) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2007007853) |
| Enumeration Date | 2015-01-20 |
| Last Update Date | 2015-03-24 |