| NPI | 1225000987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 1104) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R155950-5) |
| Enumeration Date | 2006-02-06 |
| Last Update Date | 2021-08-02 |