| NPI | 1770530511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SD SD-CRNA CR000688) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R1561137) |
| Enumeration Date | 2006-05-27 |
| Last Update Date | 2009-02-19 |