| NPI | 1679089221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2191) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 182918-3) |
| Enumeration Date | 2017-12-19 |
| Last Update Date | 2020-10-05 |