NPI | 1164095170 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CT 10929) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: CT 134480) |
367500000X Nurse Anesthetist, Certified Registered (Licence: CT NA) | |
Enumeration Date | 2021-07-19 |
Last Update Date | 2022-09-14 |