| NPI | 1174010912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN275920) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MA RN275920) |
| Enumeration Date | 2018-04-17 |
| Last Update Date | 2021-10-22 |