| NPI | 1255309357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM CRNA 01071) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R1557345) |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2011-03-16 |