| NPI | 1225602915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN2347569) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NH 076712-21) |
| Enumeration Date | 2021-05-17 |
| Last Update Date | 2023-11-14 |