| NPI | 1902299282 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 220537) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R172071) |
| Enumeration Date | 2015-03-11 |
| Last Update Date | 2015-03-11 |