| NPI | 1609464684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN782409) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R201249) |
| 163W00000X Registered Nurse (Licence: MD R201249) | |
| Enumeration Date | 2021-01-06 |
| Last Update Date | 2023-12-20 |