NPI | 1124556683 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN669685) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: PA RN669685) |
Enumeration Date | 2017-05-30 |
Last Update Date | 2020-01-06 |