| NPI | 1700011434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 082602) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN554690) |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2023-11-29 |