| NPI | 1912685488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA GAA-CRNA001582) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 29057) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NJ14870700) | |
| Enumeration Date | 2023-07-06 |
| Last Update Date | 2025-03-10 |