| NPI | 1194184580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NH 076599-23) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: ME RN657) |
| Enumeration Date | 2016-02-15 |
| Last Update Date | 2017-10-01 |