| NPI | 1962467472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2019017345) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2015001767) |
| 163W00000X Registered Nurse (Licence: KS 14-133862) | |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2026-04-21 |