NPI | 1578015277 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN9447456) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 0000171011) |
Enumeration Date | 2016-10-28 |
Last Update Date | 2024-11-06 |