| NPI | 1033191358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN138653) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA RN138653) |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2025-08-26 |