NPI | 1164962064 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95001358) |
Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OR 201701285CRNA) |
Enumeration Date | 2017-02-27 |
Last Update Date | 2021-01-29 |