| NPI | 1861241655 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: PA RN705248) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN25843) |
| Enumeration Date | 2024-05-15 |
| Last Update Date | 2025-01-22 |