| NPI | 1275376568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA GAA-CRNA004158) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: AL 1-185336) |
| Enumeration Date | 2024-06-14 |
| Last Update Date | 2026-08-05 |