| NPI | 1477520542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R1402746) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SD R027248) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2015-02-09 |