| NPI | 1801445077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ME RNA213004) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95127105) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 65596) | |
| Enumeration Date | 2019-09-10 |
| Last Update Date | 2024-05-06 |