| NPI | 1003451717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 131330) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN682782) |
| Enumeration Date | 2019-11-18 |
| Last Update Date | 2023-10-10 |