| NPI | 1710215314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 084382) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN-504474-L) |
| Enumeration Date | 2009-11-20 |
| Last Update Date | 2023-11-29 |