| NPI | 1609315969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA TLRN050941) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 644378-1) |
| Enumeration Date | 2017-02-20 |
| Last Update Date | 2018-03-01 |