| NPI | 1194007682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 6231) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 6231) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MN r1872253) | |
| Enumeration Date | 2011-09-12 |
| Last Update Date | 2023-01-26 |