NPI | 1578217626 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11019546) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9378325) |
Enumeration Date | 2022-02-08 |
Last Update Date | 2024-11-11 |