| NPI | 1942789904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2467729) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 8914) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2232) | |
| Enumeration Date | 2018-08-10 |
| Last Update Date | 2021-02-16 |