| NPI | 1841520632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN255407) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN255407) |
| Enumeration Date | 2009-12-30 |
| Last Update Date | 2016-11-21 |