| NPI | 1356066872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 142863) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: MI 4704309672) |
| Enumeration Date | 2022-10-06 |
| Last Update Date | 2023-01-06 |