NPI | 1164651709 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 9289925) |
Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2001030709) |
Enumeration Date | 2009-07-03 |
Last Update Date | 2012-08-01 |