| NPI | 1083820666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R1510560) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 1588) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 283516) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2023-02-08 |