| NPI | 1598858524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11004272) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R1485459) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2020-02-14 |