| NPI | 1972230654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA GAA-CRNA001122) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1087443) |
| Enumeration Date | 2022-08-03 |
| Last Update Date | 2024-08-30 |