| NPI | 1972680114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA 052706) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MA 215330) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2008-05-13 |