| NPI | 1467737817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA GAA-CRNA000874) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA 119119) |
| Enumeration Date | 2011-10-18 |
| Last Update Date | 2023-02-06 |