| NPI | 1669922993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 8190-33) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: WI 8190-33) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R-217897-2) | |
| Enumeration Date | 2016-10-11 |
| Last Update Date | 2023-10-13 |