| NPI | 1457655805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R175762-4) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ND R31002) |
| Enumeration Date | 2010-12-28 |
| Last Update Date | 2013-12-13 |