| NPI | 1720007206 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 054390) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN317722L) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2020-04-28 |