| NPI | 1255657540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D-107302) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R177295-5) |
| Enumeration Date | 2010-04-13 |
| Last Update Date | 2024-04-12 |