| NPI | 1821084708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN352375L) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: PA RN352375L) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 85299) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R124304) | |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2022-08-24 |