NPI | 1750800652 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 113879) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 826602) |
Enumeration Date | 2017-09-12 |
Last Update Date | 2021-12-06 |