| NPI | 1164734810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA NA84952) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY N25139) |
| 163W00000X Registered Nurse (Licence: PA RN557755) | |
| Enumeration Date | 2010-07-10 |
| Last Update Date | 2026-07-13 |