| NPI | 1417216094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 1710) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R174329-8) |
| Enumeration Date | 2012-05-16 |
| Last Update Date | 2020-10-01 |