| NPI | 1174394555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 140921) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN654555) |
| Enumeration Date | 2024-01-12 |
| Last Update Date | 2024-01-12 |