| NPI | 1235903113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: PA TLRN073765) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN733552) |
| Enumeration Date | 2023-11-10 |
| Last Update Date | 2026-05-18 |