| NPI | 1023621927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MI 4704315188) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 240598) |
| 163W00000X Registered Nurse (Licence: MN 2463300) | |
| 163W00000X Registered Nurse (Licence: IA 2463300) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 240598) | |
| Enumeration Date | 2020-08-28 |
| Last Update Date | 2022-06-26 |