| NPI | 1255755658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN243970) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: RI RN38566) |
| Enumeration Date | 2014-02-06 |
| Last Update Date | 2021-12-13 |