| NPI | 1245298520 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN125669) | 
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 4043188) | 
| Enumeration Date | 2006-05-03 | 
| Last Update Date | 2025-07-10 |