| NPI | 1205882214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11001687) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R146429-2) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2021-01-05 |