| NPI | 1932515236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN2265239) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MA RN2265239) |
| 363L00000X Nurse Practitioner (Licence: MA RN2265239) | |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2024-07-30 |