| NPI | 1770533317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN521826L) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AK 116420) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2022-07-21 |