| NPI | 1043555667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN277898) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 655493) |
| 163W00000X Registered Nurse (Licence: MI 4704279653) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R215730) | |
| Enumeration Date | 2012-12-07 |
| Last Update Date | 2024-02-15 |