NPI | 1023179801 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM R59727) |
Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 4961614-4406) |
Enumeration Date | 2006-12-13 |
Last Update Date | 2007-07-08 |