| NPI | 1063003648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN2329584) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: RI APRN04092) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MA RN2329584) | |
| Enumeration Date | 2021-01-27 |
| Last Update Date | 2024-09-13 |