| NPI | 1245012251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN707595) |
| Additional Taxonomies | 163WS0200X Registered Nurse, School (Licence: PA RN707595) |
| Enumeration Date | 2023-10-16 |
| Last Update Date | 2024-08-13 |