| NPI | 1134537574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 103357) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 806) |
| 163W00000X Registered Nurse (Licence: MN r174653-8) | |
| Enumeration Date | 2014-07-29 |
| Last Update Date | 2021-03-11 |