| NPI | 1023083789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 6451) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN505927L) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2021-01-28 |