| NPI | 1851741672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: RI APRN01811) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN2299423) |
| Enumeration Date | 2016-06-14 |
| Last Update Date | 2024-11-12 |