| NPI | 1629687751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA GAA-CRNA000247) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 30224) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1003368) | |
| Enumeration Date | 2020-07-24 |
| Last Update Date | 2026-03-09 |