| NPI | 1912946542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 1230) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 165395-30) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R132680-6) | |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2020-12-21 |