| NPI | 1326052424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R143404-4) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 4174-33) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 175478-30) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2021-03-15 |