| NPI | 1649501560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN228280) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11028122) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN RN00000X) | |
| Enumeration Date | 2010-01-15 |
| Last Update Date | 2024-11-13 |