| NPI | 1053594671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN169969) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 222091) |
| Enumeration Date | 2007-12-06 |
| Last Update Date | 2024-09-08 |