| NPI | 1508489295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN307854) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN2289951) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 817059-01) | |
| Enumeration Date | 2020-05-28 |
| Last Update Date | 2024-06-11 |