| NPI | 1588646772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 4021-33) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2003021292) |
| 363L00000X Nurse Practitioner (Licence: WI 4021-33) | |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2023-08-24 |