| NPI | 1760980940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN220093) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: GA RN220093) |
| Enumeration Date | 2018-01-23 |
| Last Update Date | 2024-07-30 |