| NPI | 1275746984 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 1390)  | 
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R 140825-8)  | 
| Enumeration Date | 2007-05-08 | 
| Last Update Date | 2020-10-05 |