| NPI | 1013375914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN236372) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN677792) |
| Enumeration Date | 2016-02-05 |
| Last Update Date | 2022-09-08 |