| NPI | 1609817139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ND R25655) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R114888-0) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2023-12-20 |