| NPI | 1770968471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ME RNA163003) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 766863) |
| Enumeration Date | 2015-07-23 |
| Last Update Date | 2019-04-09 |