| NPI | 1255302337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 2794) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R150350-6) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2023-01-11 |