NPI | 1649685579 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 9277331) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9277331) |
163W00000X Registered Nurse (Licence: PA 638472) | |
163W00000X Registered Nurse (Licence: NY 664129) | |
Enumeration Date | 2014-06-30 |
Last Update Date | 2014-11-16 |