| NPI | 1508168832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA 086832) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN257029) |
| Enumeration Date | 2010-11-18 |
| Last Update Date | 2011-12-29 |