| NPI | 1679682546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 1273) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R163962-9) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2019-06-10 |