| NPI | 1992687024 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 3237) | 
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 2041245) | 
| Enumeration Date | 2025-07-21 | 
| Last Update Date | 2025-09-15 |