| NPI | 1093490005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704314888) |
| Additional Taxonomies | 163WP0200X Registered Nurse, Pediatrics (Licence: MI 4704314888) |
| Enumeration Date | 2023-06-19 |
| Last Update Date | 2023-08-18 |