| NPI | 1477162196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 132391) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 2335346) |
| Enumeration Date | 2020-07-28 |
| Last Update Date | 2020-09-18 |