| NPI | 1982640348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 12.009499) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: RI APRN01300) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MA 209552) | |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2025-11-03 |