| NPI | 1821505280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MA RN283519) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NH 059871-23) |
| Enumeration Date | 2018-01-08 |
| Last Update Date | 2025-03-05 |