| NPI | 1356737175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN644703) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9352179) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 9352179) | |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2024-06-10 |