| NPI | 1073532032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN123295) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 192749) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 18085) | |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2023-03-20 |