| NPI | 1588642227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN201822L) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA RN201822L) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2015-03-12 |