| NPI | 1386891976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN CRNA1717) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN R1561564) |
| Enumeration Date | 2008-08-26 |
| Last Update Date | 2024-04-11 |