| NPI | 1912939406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN apn 10312) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC APN3520) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2022-03-29 |