| NPI | 1720210842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN548175) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: NJ 26NR13112500) |
| Enumeration Date | 2009-08-24 |
| Last Update Date | 2014-03-07 |