| NPI | 1659777670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 605854) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN2266306) |
| 163W00000X Registered Nurse (Licence: MA RN2266306) | |
| Enumeration Date | 2014-11-19 |
| Last Update Date | 2025-02-19 |