| NPI | 1427095611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN263558) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN545547) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2022-10-24 |