| NPI | 1124042908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MN R 074029-2) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 026303) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2007-07-08 |