| NPI | 1063898948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R212014-0) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 168151-30) |
| Enumeration Date | 2015-08-03 |
| Last Update Date | 2020-09-25 |