| NPI | 1588769103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 77758) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R141295-6) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2014-05-07 |