| NPI | 1902135064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 162409) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R 173491-9) |
| Enumeration Date | 2009-12-18 |
| Last Update Date | 2021-10-14 |