| NPI | 1063810406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MN R 233672-0) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2021022479) |
| 163W00000X Registered Nurse (Licence: MO 2024033495) | |
| Enumeration Date | 2014-12-17 |
| Last Update Date | 2025-03-28 |