| NPI | 1306476288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 1103298) |
| Additional Taxonomies | 163WS0200X Registered Nurse, School (Licence: MN 2458869) |
| Enumeration Date | 2020-01-20 |
| Last Update Date | 2023-03-29 |