NPI | 1912373507 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3009650) |
Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN APN 21622) |
Enumeration Date | 2015-08-18 |
Last Update Date | 2022-10-05 |