| NPI | 1467879312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 11440) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: MN R 207237-9) |
| Enumeration Date | 2014-03-27 |
| Last Update Date | 2023-05-11 |