| NPI | 1609855295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 0653) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R1305076) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2020-12-18 |