| NPI | 1760456198 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 196) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R134625-5) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2022-07-20 |