| NPI | 1194184762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN242683) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN242683) |
| 163W00000X Registered Nurse (Licence: AL 1-132401) | |
| Enumeration Date | 2016-02-11 |
| Last Update Date | 2016-02-11 |