| NPI | 1730171588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R1005525) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 108993) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2014-01-24 |