NPI | 1063914562 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN9482935) |
Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 115464) |
Enumeration Date | 2018-03-01 |
Last Update Date | 2021-01-14 |