| NPI | 1598799819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 815) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 1708877) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2025-06-09 |