NPI | 1407278054 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 9413381) |
Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 1-108160) |
367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3009357) | |
Enumeration Date | 2014-01-16 |
Last Update Date | 2017-04-04 |