| NPI | 1417386483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R 229934-3) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024171445) |
| Enumeration Date | 2013-11-10 |
| Last Update Date | 2018-12-19 |