| NPI | 1851543516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 081789) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN518009-L) |
| Enumeration Date | 2008-10-14 |
| Last Update Date | 2021-01-25 |