| NPI | 1629507934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ME RNA193015) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MA RN2270507) |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2019-06-14 |