NPI | 1003269028 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R174585) |
Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP9298958) |
Enumeration Date | 2016-07-14 |
Last Update Date | 2019-12-02 |