NPI | 1023180205 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 46555) |
Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH 06389) |
Enumeration Date | 2006-11-14 |
Last Update Date | 2011-09-23 |