| NPI | 1174708986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA Natl Cert # 077959) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN521960L) |
| Enumeration Date | 2007-12-31 |
| Last Update Date | 2021-03-11 |