| NPI | 1700284080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN182547) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 29195) |
| Enumeration Date | 2014-12-18 |
| Last Update Date | 2026-01-27 |