| NPI | 1326490251 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN CRNA 1961) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN R 196827-7) |
| 163W00000X Registered Nurse (Licence: WI 000000000195481) | |
| Enumeration Date | 2016-07-03 |
| Last Update Date | 2023-03-14 |