| NPI | 1740356641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: RI APRN00831) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: RI RNA20248) |
| Enumeration Date | 2006-11-24 |
| Last Update Date | 2022-10-27 |