| NPI | 1730144031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN CRNA 0163) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R 131290-4) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2017-04-19 |