| NPI | 1336656123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN223533) |
| Additional Taxonomies | 163WP0000X Registered Nurse Pain Management (Licence: GA RN223533) |
| 163W00000X Registered Nurse (Licence: GA RN223533) | |
| Enumeration Date | 2018-01-03 |
| Last Update Date | 2023-06-26 |