NPI | 1104571785 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11020213) |
Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL RN9319347) |
Enumeration Date | 2022-02-13 |
Last Update Date | 2025-09-24 |