| NPI | 1003923582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 153789-030) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 144267-0) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2022-04-08 |