| NPI | 1164725511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: MN R174225-7) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN ccna0086627) |
| Enumeration Date | 2010-12-07 |
| Last Update Date | 2014-06-17 |