| 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 |