| NPI | 1538739859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: PA RN693420) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN693420) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA RN693420) | |
| Enumeration Date | 2021-06-29 |
| Last Update Date | 2024-09-12 |