| NPI | 1588200968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2433) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 259431) |
| Enumeration Date | 2019-11-21 |
| Last Update Date | 2021-06-01 |