| NPI | 1891259792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 242738-30) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 1936076) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 13530-33) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2324) | |
| Enumeration Date | 2019-01-24 |
| Last Update Date | 2024-11-21 |