| NPI | 1003880196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN246877) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 18399) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2023-04-13 |