| NPI | 1770033508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 113439) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN633890) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: PA RN633890) | |
| Enumeration Date | 2016-10-05 |
| Last Update Date | 2017-01-30 |