| NPI | 1508843525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 1173) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 46711) |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2020-10-02 |