| NPI | 1639850837 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704346487) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95252236) |
| Enumeration Date | 2023-07-31 |
| Last Update Date | 2024-12-18 |