| NPI | 1992892996 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: ND PAC00010) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ND R17894) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2007-07-08 |