NPI | 1417354499 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3009569) |
Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WV 89865) |
Enumeration Date | 2014-11-19 |
Last Update Date | 2023-07-19 |