| NPI | 1821523986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN641349) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN641349) |
| 163W00000X Registered Nurse (Licence: NY 695200-1) | |
| Enumeration Date | 2017-04-26 |
| Last Update Date | 2019-06-10 |