| NPI | 1275266959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704309634) |
| Additional Taxonomies | 163WS0200X Registered Nurse, School (Licence: MI 4704309634) |
| 207L00000X Anesthesiology (Licence: MI 4704309634) | |
| Enumeration Date | 2022-07-08 |
| Last Update Date | 2023-10-26 |