| NPI | 1568465201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 202157-30) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R-081276-4) |
| Enumeration Date | 2005-05-26 |
| Last Update Date | 2014-04-16 |