| NPI | 1801165592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 347) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R190783-0) |
| Enumeration Date | 2011-12-25 |
| Last Update Date | 2023-03-14 |