| NPI | 1770866915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 1933) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 1493357) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 166947) | |
| Enumeration Date | 2011-09-23 |
| Last Update Date | 2022-11-17 |