NPI | 1053605758 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: LA AP06561) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: LA RN117173) |
Enumeration Date | 2011-05-31 |
Last Update Date | 2019-04-30 |