| NPI | 1619379070 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN CRNA 1742) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D136694) |
| Enumeration Date | 2014-09-17 |
| Last Update Date | 2016-01-25 |