| NPI | 1982368866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704318026) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704318026) |
| Enumeration Date | 2021-10-26 |
| Last Update Date | 2022-05-29 |