| NPI | 1275923781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: RI APRN00302) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN277232) |
| Enumeration Date | 2015-02-04 |
| Last Update Date | 2021-09-16 |