| NPI | 1306450440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2876) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 195708-4) |
| Enumeration Date | 2020-09-05 |
| Last Update Date | 2025-09-18 |