| NPI | 1962833715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: RI APRN01310) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA 2282921) |
| 163W00000X Registered Nurse (Licence: MA RN2282921) | |
| Enumeration Date | 2013-12-04 |
| Last Update Date | 2021-04-14 |