| NPI | 1477521375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 100010-30) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R132969-6) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2020-12-28 |