| NPI | 1598729378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R1122657) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2007-07-08 |