| NPI | 1174884464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN198729) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 235930) |
| Enumeration Date | 2012-06-03 |
| Last Update Date | 2023-02-06 |