| NPI | 1831743368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 9395205) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA GAA-CRNA000391) |
| Enumeration Date | 2019-08-01 |
| Last Update Date | 2025-08-03 |