| NPI | 1235954918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN704480) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: PA RN704480) |
| Enumeration Date | 2024-11-18 |
| Last Update Date | 2025-01-28 |