| NPI | 1023683984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN2304236) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NH 086161-23) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2021-05-24 |
| Last Update Date | 2023-05-08 |