| NPI | 1124718911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN697025) |
| Additional Taxonomies | 163WP2201X Registered Nurse, Ambulatory Care (Licence: PA RN697025) |
| Enumeration Date | 2023-05-15 |
| Last Update Date | 2023-10-20 |