| NPI | 1821377607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA0790) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R 178027-7) |
| Enumeration Date | 2011-08-10 |
| Last Update Date | 2023-05-11 |