| NPI | 1770757221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ND R30432) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R163138-4) |
| Enumeration Date | 2008-04-16 |
| Last Update Date | 2012-10-30 |