| NPI | 1871747121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: RI APRN00564) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA 278696) |
| Enumeration Date | 2008-11-13 |
| Last Update Date | 2019-07-26 |