| NPI | 1891072005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI CRNA1019) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 0000000) |
| Enumeration Date | 2011-11-16 |
| Last Update Date | 2022-11-30 |