| NPI | 1134664048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ND R34422) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R218913-6) |
| Enumeration Date | 2016-12-31 |
| Last Update Date | 2016-12-31 |