| NPI | 1073649695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R 189055-2) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: WI 155462-030) |
| Enumeration Date | 2007-02-26 |
| Last Update Date | 2025-07-17 |