| NPI | 1609022961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 078593) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN513131L) |
| Enumeration Date | 2008-08-18 |
| Last Update Date | 2021-01-18 |