| NPI | 1639572860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ME RNA143040) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: ME RN65422) |
| Enumeration Date | 2014-10-02 |
| Last Update Date | 2014-10-06 |