| NPI | 1043797111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2245) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN R196293-0) |
| 163W00000X Registered Nurse (Licence: WI 180010-30) | |
| Enumeration Date | 2018-07-23 |
| Last Update Date | 2018-10-22 |