NPI | 1124016415 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C01434) |
Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MS A810403) |
Enumeration Date | 2005-10-11 |
Last Update Date | 2019-08-19 |