NPI | 1063418200 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN135363) |
Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 55340) |
367500000X Nurse Anesthetist, Certified Registered (Licence: AL 1-085935) | |
Enumeration Date | 2005-06-22 |
Last Update Date | 2022-09-09 |