NPI | 1477076107 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 9397757) |
Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1011922) |
Enumeration Date | 2017-07-25 |
Last Update Date | 2021-01-21 |