| NPI | 1790757201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 353) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R076038-2) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2019-05-03 |