| NPI | 1003565078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: DE L6-0A10940) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN719847) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN719847) | |
| Enumeration Date | 2022-03-18 |
| Last Update Date | 2024-04-30 |