| NPI | 1982610242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN195134) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 3485) |
| 163W00000X Registered Nurse (Licence: NC 3455344W) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2025-11-03 |