| NPI | 1043298003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN162229) |
| Additional Taxonomies | 163WC1500X Registered Nurse, Community Health (Licence: GA rn162229) |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2020-12-15 |