| NPI | 1750374880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 1762745) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 648147) |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2019-01-10 |