| NPI | 1790006542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ME RNA213056) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS R878585) |
| Enumeration Date | 2010-06-16 |
| Last Update Date | 2021-10-12 |