| NPI | 1962473587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 9562) |
| Additional Taxonomies | 163WP0000X Registered Nurse, Pain Management (Licence: TN RN053103) |
| Enumeration Date | 2006-01-31 |
| Last Update Date | 2019-05-13 |