| NPI | 1164662946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R 161849-4) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 153) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 263035) | |
| Enumeration Date | 2009-03-06 |
| Last Update Date | 2021-10-25 |