| NPI | 1992153506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA 110943) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 22509) |
| Enumeration Date | 2016-05-25 |
| Last Update Date | 2026-03-05 |