NPI | 1114264801 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP136733) |
Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C002942) |
367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209010158) | |
Enumeration Date | 2013-01-15 |
Last Update Date | 2021-04-07 |