| NPI | 1609854454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: RI RNA36599) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN242566) |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2021-06-28 |