| NPI | 1740624006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN277255) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: RI RN49603) |
| Enumeration Date | 2013-04-17 |
| Last Update Date | 2020-06-27 |