| NPI | 1124020060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN509304L) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN509304-L) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 858778) | |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2022-10-11 |