| NPI | 1700254331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN2353222) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 089214) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 089214) | |
| Enumeration Date | 2015-09-14 |
| Last Update Date | 2021-09-07 |