NPI | 1487905816 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 163W00000X Registered Nurse (Licence: CA 532839) |
Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: HI 1215) |
367500000X Nurse Anesthetist, Certified Registered (Licence: CA 4296) | |
Enumeration Date | 2012-09-25 |
Last Update Date | 2021-03-17 |