| NPI | 1003456831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: PA RN681402) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 141265) |
| Enumeration Date | 2020-01-09 |
| Last Update Date | 2023-01-24 |