| NPI | 1376737536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ND R25292) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R163560-7) |
| Enumeration Date | 2007-08-30 |
| Last Update Date | 2019-03-01 |