| NPI | 1588091565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 101293) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA RN529489L) |
| Enumeration Date | 2013-10-04 |
| Last Update Date | 2014-01-03 |