| NPI | 1467945295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95001647) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ME RNA203074) |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2023-02-06 |