| NPI | 1205172921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ND R33346) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 1476) |
| Enumeration Date | 2012-12-28 |
| Last Update Date | 2023-12-28 |