| NPI | 1053369173 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: RI RNA36635) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN246965) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2023-03-08 |