| NPI | 1083322051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN CRNA2787) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN R2308483) |
| Enumeration Date | 2022-11-09 |
| Last Update Date | 2024-09-12 |