| NPI | 1982140844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA GAA-CRNA000891) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MS 877434) |
| Enumeration Date | 2017-01-16 |
| Last Update Date | 2022-08-16 |