| NPI | 1598816092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 5892) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R0979254) |
| Enumeration Date | 2007-01-13 |
| Last Update Date | 2024-04-10 |