| NPI | 1174628705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R137597-0) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ 280028) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2023-03-27 |