NPI | 1104103027 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 88977) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MN R 181776-8) |
Enumeration Date | 2011-11-06 |
Last Update Date | 2012-04-27 |