| NPI | 1982600557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA 146986) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ME 46667) |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2008-07-03 |