| NPI | 1871730804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 13898) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 133054) |
| Enumeration Date | 2009-01-13 |
| Last Update Date | 2010-08-12 |