| NPI | 1114240413 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN252573) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: RI APRN03524) |
| Enumeration Date | 2010-03-02 |
| Last Update Date | 2024-08-15 |