| NPI | 1366934614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN2287426) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA RN2287426) |
| Enumeration Date | 2018-06-02 |
| Last Update Date | 2020-11-10 |