| NPI | 1821062506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 30) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R112313-5) |
| Enumeration Date | 2006-02-17 |
| Last Update Date | 2021-01-06 |