| NPI | 1447581483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA 918882) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA 260729) |
| Enumeration Date | 2010-01-14 |
| Last Update Date | 2017-08-31 |