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 |