| NPI | 1295128783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 6492) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 132882) |
| 163W00000X Registered Nurse (Licence: MA RN2300423) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN2300423) | |
| Enumeration Date | 2015-03-09 |
| Last Update Date | 2023-07-17 |