| NPI | 1902132822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 083445) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MN R 170476-1) |
| Enumeration Date | 2009-10-28 |
| Last Update Date | 2022-05-25 |