| NPI | 1043635360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN CRNA0748) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R187104-7) |
| Enumeration Date | 2014-02-24 |
| Last Update Date | 2020-12-18 |