NPI | 1083246847 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704297148) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704297148) |
Enumeration Date | 2020-02-10 |
Last Update Date | 2021-11-03 |