| NPI | 1346774148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN2302541) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2302541) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NH 085689-23) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 7577) | |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2024-03-06 |