| NPI | 1942752035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 22194) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA 111111) |
| Enumeration Date | 2016-10-25 |
| Last Update Date | 2017-02-15 |