NPI | 1164072112 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11000510) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: FL APRN11000510) |
Enumeration Date | 2019-09-11 |
Last Update Date | 2023-03-27 |