NPI | 1568764173 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 163W00000X Registered Nurse (Licence: AK 35187) |
Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MT 73185) |
Enumeration Date | 2010-12-02 |
Last Update Date | 2019-03-07 |