| NPI | 1154623643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN533340) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA rn533340) |
| Enumeration Date | 2010-12-03 |
| Last Update Date | 2014-05-13 |