| NPI | 1376174672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2454) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 1110567) |
| Enumeration Date | 2020-01-27 |
| Last Update Date | 2024-02-13 |