| NPI | 1033173174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 2888) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN R 148370-7) |
| 163W00000X Registered Nurse (Licence: WI 143632-030) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 070361) | |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2024-04-10 |