| NPI | 1336252923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA 031545) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA 119746) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2008-06-23 |