| NPI | 1588668362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2540) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 116405) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2024-01-22 |