| NPI | 1861494387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA TLRN060830) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R139828) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2021-01-27 |