| NPI | 1922626001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN2302282) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA RN2302282) |
| 163W00000X Registered Nurse (Licence: NH 074383-21) | |
| 207L00000X Anesthesiology (Licence: MA RN2302282) | |
| Enumeration Date | 2020-07-06 |
| Last Update Date | 2022-12-01 |