| NPI | 1114330529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN234915) |
| Additional Taxonomies | 364SS0200X Clinical Nurse Specialist, School (Licence: MA RN234915) |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2025-11-06 |