| NPI | 1194398867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN667292) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN667292) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3017184) | |
| Enumeration Date | 2021-07-21 |
| Last Update Date | 2025-08-15 |