NPI | 1285208231 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 29607) |
Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 100951) |
163W00000X Registered Nurse (Licence: TN 250270) | |
Enumeration Date | 2021-05-14 |
Last Update Date | 2023-10-20 |