| NPI | 1659972206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN680795) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: PA RN.680795) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: OH RN.417077) | |
| Enumeration Date | 2020-11-02 |
| Last Update Date | 2022-08-23 |