NPI | 1063508281 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 104015) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 104015) |
Enumeration Date | 2006-10-05 |
Last Update Date | 2020-11-24 |