| NPI | 1982661310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN2281199) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2020012173) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 097225) | |
| Enumeration Date | 2006-04-28 |
| Last Update Date | 2024-04-03 |