| NPI | 1285199349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 1019733) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 193679-1) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2316) | |
| Enumeration Date | 2019-02-04 |
| Last Update Date | 2023-06-29 |