| NPI | 1730556937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VT 101.0134462) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN260367) |
| 207L00000X Anesthesiology (Licence: VT 101.0134462) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA RN260367) | |
| Enumeration Date | 2015-08-24 |
| Last Update Date | 2023-07-19 |