| NPI | 1790521425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: RI APRN04818) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NH 112573-23) |
| 163W00000X Registered Nurse (Licence: NH 112573-21) | |
| Enumeration Date | 2024-07-02 |
| Last Update Date | 2026-01-05 |