| NPI | 1275818643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VT 101.0135229) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2277523) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN2277523) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NH 089456-23) | |
| Enumeration Date | 2011-10-18 |
| Last Update Date | 2022-12-06 |