| NPI | 1639622616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN282661) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 217316) |
| Enumeration Date | 2016-07-26 |
| Last Update Date | 2026-07-28 |