| NPI | 1689959777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN CRNA 1911) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 169078-30) |
| Enumeration Date | 2011-10-20 |
| Last Update Date | 2017-05-02 |