| NPI | 1447247671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC 1730A) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ME RNA213015) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: SC R89933) | |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2022-10-24 |