| NPI | 1952197121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 3182) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 2533314) |
| Enumeration Date | 2025-04-15 |
| Last Update Date | 2025-06-30 |