| NPI | 1346774486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2117) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: WI R172975-30) |
| 163W00000X Registered Nurse (Licence: MN R224693-0) | |
| Enumeration Date | 2017-04-15 |
| Last Update Date | 2024-07-25 |