NPI | 1144774878 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95000541) |
Additional Taxonomies | 2084P0804X Psychiatry & Neurology Child & Adolescent Psychiatry (Licence: NY 754541) |
Enumeration Date | 2016-08-10 |
Last Update Date | 2023-07-17 |