| NPI | 1013685478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN274574) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN274574) |
| Enumeration Date | 2021-09-01 |
| Last Update Date | 2024-05-22 |