| NPI | 1518947274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN298511L) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 18360) |
| Enumeration Date | 2006-01-19 |
| Last Update Date | 2025-04-25 |