| NPI | 1780061754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: DE 103052) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: DE l1-0034009) |
| 163W00000X Registered Nurse (Licence: NJ 26nr15684500) | |
| 163W00000X Registered Nurse (Licence: PA rn535061) | |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2016-04-25 |