| NPI | 1982005005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN610009) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: PA RN610009) |
| 163WP0807X Registered Nurse, Psych/Mental Health, Child & Adolescent (Licence: PA RN610009) | |
| Enumeration Date | 2014-09-08 |
| Last Update Date | 2022-03-31 |