| NPI | 1235104811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 164) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R101350-4) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2020-10-02 |