| NPI | 1699024679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 0480) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R1790994) |
| Enumeration Date | 2012-09-05 |
| Last Update Date | 2020-10-02 |