NPI | 1053971903 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA CRNA95002353) |
Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: OH 427194) |
367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NJ01250800) | |
Enumeration Date | 2019-06-13 |
Last Update Date | 2024-07-25 |