| NPI | 1336612795 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THOMAS DAVID BOOSTROM Co Owner 507-206-1680 |
| Organization Subpart ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered |
| Enumeration Date | 2019-01-09 |
| Last Update Date | 2019-04-11 |