| NPI | 1184790651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 12699) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 9179392) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN187389) | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2023-04-05 |