NPI | 1083134290 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: GU 100469) |
Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AL 1-176077) |
367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11014640) | |
367500000X Nurse Anesthetist, Certified Registered (Licence: RI APRN01611) | |
Enumeration Date | 2017-06-20 |
Last Update Date | 2025-09-16 |