NPI | 1396318457 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN2284750) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: MA RN2284750) |
Enumeration Date | 2021-07-19 |
Last Update Date | 2022-08-26 |