| NPI | 1629705074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: MN 2757) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN 2148892) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2757) | |
| Enumeration Date | 2022-08-05 |
| Last Update Date | 2022-10-28 |