| NPI | 1356314256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 0494) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R090471-1) |
| Enumeration Date | 2006-02-10 |
| Last Update Date | 2019-04-22 |