| NPI | 1609465947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN240752) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 26161) |
| Enumeration Date | 2021-01-12 |
| Last Update Date | 2024-03-15 |