| NPI | 1427821040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2953) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 16004) |
| Enumeration Date | 2023-11-06 |
| Last Update Date | 2025-01-14 |