| NPI | 1265402929 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 717) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R131650-2) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2020-10-05 |