| NPI | 1700251899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN645278) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN645278) |
| Enumeration Date | 2015-12-01 |
| Last Update Date | 2016-12-19 |