| NPI | 1750792966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2047) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D136691) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CA NA95000441) | |
| Enumeration Date | 2014-05-12 |
| Last Update Date | 2023-06-29 |