| NPI | 1245746312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ME RNA213075) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 104701) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2017-12-27 |
| Last Update Date | 2022-01-11 |