| NPI | 1932825817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: PA RN701074) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 150023) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN701074) | |
| Enumeration Date | 2022-10-13 |
| Last Update Date | 2024-08-28 |