NPI | 1174892491 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN9473832) |
Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: OH RN330426) |
367500000X Nurse Anesthetist, Certified Registered (Licence: NY 742752) | |
Enumeration Date | 2011-12-15 |
Last Update Date | 2025-07-29 |