| NPI | 1780673459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN093384) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC APN28204) |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2025-10-15 |