| NPI | 1043561004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MN R160593-8) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 091716) |
| Enumeration Date | 2012-09-30 |
| Last Update Date | 2012-09-30 |