NPI | 1710254594 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX AP121342) |
Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 717390) |
Enumeration Date | 2011-11-22 |
Last Update Date | 2022-08-11 |