| NPI | 1912973132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R1371796) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D093563) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2024-01-11 |