| NPI | 1841907227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN CRNA2785) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN R2449740) |
| Enumeration Date | 2022-11-03 |
| Last Update Date | 2024-09-11 |