NPI | 1720635873 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95001689) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 95052605) |
Enumeration Date | 2019-08-22 |
Last Update Date | 2022-03-08 |