NPI | 1114528015 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95001486) |
Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: CA 95167168) |
367500000X Nurse Anesthetist, Certified Registered (Licence: IA D175480) | |
Enumeration Date | 2020-11-06 |
Last Update Date | 2023-09-27 |