| NPI | 1780761924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA 019445) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA 180748) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2008-04-29 |