| NPI | 1760849921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN2265881) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: ME RN67056) |
| Enumeration Date | 2016-01-19 |
| Last Update Date | 2019-10-28 |