NPI | 1487701652 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D126589) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IA d126589) |
367500000X Nurse Anesthetist, Certified Registered (Licence: MN 076713) | |
Enumeration Date | 2007-01-03 |
Last Update Date | 2023-04-20 |