| NPI | 1073306189 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA APRN-CRNA278463) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN278463) |
| Enumeration Date | 2025-05-22 |
| Last Update Date | 2025-10-16 |