NPI | 1902294366 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA RN244914) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: OH 317661) |
163W00000X Registered Nurse (Licence: KY 1131140) | |
163W00000X Registered Nurse (Licence: IN 28213083A) | |
Enumeration Date | 2015-01-07 |
Last Update Date | 2015-02-27 |