NPI | 1639161029 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 096869) |
Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: SC APN 323) |
Enumeration Date | 2005-08-22 |
Last Update Date | 2020-10-28 |