| NPI | 1790731735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R104731-8) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN R1047318) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2014-04-11 |