NPI | 1205464005 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11013432) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9385383) |
Enumeration Date | 2020-03-29 |
Last Update Date | 2021-06-05 |