| NPI | 1720357999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 141134) |
| Additional Taxonomies | 163WH0200X Registered Nurse, Home Health (Licence: WI 141134-30) |
| Enumeration Date | 2011-12-18 |
| Last Update Date | 2023-10-18 |