| NPI | 1952676488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R 190059-4) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 5598-033) |
| Enumeration Date | 2012-03-16 |
| Last Update Date | 2023-10-25 |