| NPI | 1114278876 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 0533) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital (Licence: MN R 165009-3) |
| Enumeration Date | 2012-09-20 |
| Last Update Date | 2021-03-09 |