| NPI | 1578165601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN2349127) |
| Additional Taxonomies | 163WS0200X Registered Nurse, School (Licence: CT 156300) |
| Enumeration Date | 2020-11-13 |
| Last Update Date | 2024-01-19 |