| NPI | 1730510629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 1251) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 8916) |
| 163W00000X Registered Nurse (Licence: MN 201864-7) | |
| Enumeration Date | 2013-12-03 |
| Last Update Date | 2020-10-13 |