| NPI | 1255768982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R196328-5) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 196328-5) |
| Enumeration Date | 2013-09-26 |
| Last Update Date | 2024-01-30 |