| NPI | 1811949555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 1071412) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA GAA-CRNA001829) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2025-11-03 |