| NPI | 1427514413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN232291) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 33673) |
| Enumeration Date | 2019-02-14 |
| Last Update Date | 2025-10-19 |