| NPI | 1366940009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD AC004493) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 24097) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN233459) | |
| Enumeration Date | 2018-01-29 |
| Last Update Date | 2025-06-25 |