NPI | 1396460481 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 98754) |
Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1096163) |
Enumeration Date | 2022-10-11 |
Last Update Date | 2025-04-09 |