| NPI | 1184038937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11012796) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R 224224-8) |
| Enumeration Date | 2014-06-19 |
| Last Update Date | 2024-12-05 |