| NPI | 1477552180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ME RNA243046) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN096410) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: LA 073148) | |
| Enumeration Date | 2005-07-15 |
| Last Update Date | 2024-09-18 |