| NPI | 1881970002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: PA RN 348512-L) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: HI RN 53202) |
| 163W00000X Registered Nurse (Licence: OH RN 270188) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 348512) | |
| Enumeration Date | 2011-11-02 |
| Last Update Date | 2012-02-06 |