| NPI | 1215971577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN302937L) |
| Additional Taxonomies | 174400000X Specialist (Licence: NJ 26NR07223900) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2022-06-30 |