| NPI | 1558398164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN302653) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AK NURA451) |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2023-05-09 |