| NPI | 1689640518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN111991) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN RN103349) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN09974) | |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2019-04-09 |