| NPI | 1871106732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 28200) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 205767) |
| Enumeration Date | 2020-08-28 |
| Last Update Date | 2020-09-22 |