| NPI | 1790357739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2628) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704307869) |
| Enumeration Date | 2021-07-10 |
| Last Update Date | 2021-10-14 |