| NPI | 1568624062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN525702L) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: PA rn525702L) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2020-03-16 |