| NPI | 1053385419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 459) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R-134718-6) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 221376) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 6251) | |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2020-10-05 |