| NPI | 1487083044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 100386) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN R-183123-6) |
| Enumeration Date | 2013-11-04 |
| Last Update Date | 2014-01-02 |