| NPI | 1699747071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 974) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R118082-2) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2020-10-01 |