| NPI | 1659359834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 134) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R 140463-4) |
| Enumeration Date | 2006-01-06 |
| Last Update Date | 2019-05-02 |