| NPI | 1972800290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 582) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R159981-1) |
| Enumeration Date | 2011-02-23 |
| Last Update Date | 2020-10-02 |