| NPI | 1891568150 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2919) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MN 2493304) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2023-10-30 |
| Last Update Date | 2024-03-07 |