NPI | 1083041057 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 73670) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: WV 73670) |
367500000X Nurse Anesthetist, Certified Registered (Licence: PA 101295) | |
Enumeration Date | 2013-10-04 |
Last Update Date | 2018-03-17 |