| NPI | 1639590102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 8199) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 8199) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R147556-6) | |
| Enumeration Date | 2013-12-30 |
| Last Update Date | 2023-01-26 |