| NPI | 1790459311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2611) |
| Additional Taxonomies | 363A00000X Physician Assistant (Licence: MN 2360531) |
| Enumeration Date | 2021-08-06 |
| Last Update Date | 2022-02-05 |