| NPI | 1801370705 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 215328-5) | 
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2153285) | 
| Enumeration Date | 2018-09-18 | 
| Last Update Date | 2019-01-10 |