| NPI | 1982090718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AK 189110) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2010036117) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2023012429) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 557336) | |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2023-06-08 |