| NPI | 1962928796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 23152) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN rn0000190692) |
| Enumeration Date | 2017-08-14 |
| Last Update Date | 2017-09-13 |