| NPI | 1104581586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2859) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI 231479-30) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 231479) | |
| Enumeration Date | 2021-11-01 |
| Last Update Date | 2024-08-06 |