| NPI | 1477897569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 1337) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2104519) |
| Enumeration Date | 2012-11-15 |
| Last Update Date | 2020-08-04 |