| NPI | 1811054505 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D126271) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R134575-1) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2022-02-15 |