| NPI | 1649116005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 242T00000X Perfusionist (Licence: MN 5373) |
| Additional Taxonomies | 2278P3900X Respiratory Therapist, Certified, Neonatal/Pediatrics (Licence: FL RT9521) |
| 2279C0205X Respiratory Therapist, Registered, Critical Care (Licence: MN 5373) | |
| Enumeration Date | 2026-04-28 |
| Last Update Date | 2026-04-28 |