| NPI | 1801552161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ND R51646) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 2363567) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2363567) | |
| Enumeration Date | 2021-11-11 |
| Last Update Date | 2022-03-30 |