| NPI | 1114328747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2836) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 820163) |
| Enumeration Date | 2014-09-15 |
| Last Update Date | 2023-06-20 |