| NPI | 1861062713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 141316) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN683699) |
| Enumeration Date | 2021-07-01 |
| Last Update Date | 2022-05-13 |