| NPI | 1962740944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA GAA-CRNA000736) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC APN.18105 APRN) |
| Enumeration Date | 2013-01-25 |
| Last Update Date | 2023-02-01 |