| NPI | 1275078701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 68048 - 030) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R 242080-8) |
| Enumeration Date | 2016-12-19 |
| Last Update Date | 2018-01-11 |