| NPI | 1306383336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN617398) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 114444) |
| Enumeration Date | 2017-01-29 |
| Last Update Date | 2024-10-29 |