| NPI | 1912083379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 12486) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 136698) |
| Enumeration Date | 2006-10-28 |
| Last Update Date | 2019-02-06 |