| NPI | 1932200987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN290056) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 42035) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2025-10-19 |