| NPI | 1649479403 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 621) | 
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R1108189) | 
| Enumeration Date | 2007-07-12 | 
| Last Update Date | 2021-03-09 |