| NPI | 1629794367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2779) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 2273149) |
| Enumeration Date | 2022-10-14 |
| Last Update Date | 2026-03-21 |