NPI | 1003468190 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1130963) |
Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 647231) |
Enumeration Date | 2019-07-10 |
Last Update Date | 2024-11-20 |