NPI | 1568456093 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: SD RO14728) |
Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WY 12580.0880) |
Enumeration Date | 2005-09-12 |
Last Update Date | 2010-01-21 |