| NPI | 1407219959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN CRNA 1904) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 7087) |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2019-12-18 |