| NPI | 1578524492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN205574L) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WV 41453) |
| 207L00000X Anesthesiology (Licence: PA RN205574L) | |
| Enumeration Date | 2006-03-30 |
| Last Update Date | 2021-10-01 |