| NPI | 1144874074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN236953) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN236953) |
| 163W00000X Registered Nurse (Licence: NC 290433) | |
| Enumeration Date | 2019-07-29 |
| Last Update Date | 2019-10-30 |