| NPI | 1275831182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 1495) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN r 166053-3) |
| Enumeration Date | 2011-03-02 |
| Last Update Date | 2020-08-04 |