| NPI | 1154384048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R146096-6) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 645158) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2016-01-25 |