| NPI | 1669880266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 103364) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN R 151052-8) |
| 163W00000X Registered Nurse (Licence: WI 189321-30) | |
| Enumeration Date | 2014-07-27 |
| Last Update Date | 2014-10-01 |