| NPI | 1912418690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 23731) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 194264) |
| Enumeration Date | 2017-10-20 |
| Last Update Date | 2020-03-25 |