| NPI | 1932241692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11014191) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN572675) |
| 163W00000X Registered Nurse (Licence: PA 572675) | |
| 163W00000X Registered Nurse (Licence: LA 105088) | |
| Enumeration Date | 2007-02-12 |
| Last Update Date | 2024-03-21 |