| NPI | 1275588378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN232839L) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN232839L) |
| 174400000X Specialist (Licence: PA AANA#034631) | |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2020-02-12 |