| NPI | 1972184315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN10005388) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 136407) |
| 163W00000X Registered Nurse (Licence: CT 176915) | |
| Enumeration Date | 2021-04-17 |
| Last Update Date | 2024-10-31 |