| NPI | 1487759098 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 3033) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA 240789) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: RI RNA36603) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2023-06-13 |