| NPI | 1851168165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2920) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 201928-0) |
| Enumeration Date | 2023-12-06 |
| Last Update Date | 2024-07-29 |