NPI | 1588646772 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 4021-33) |
Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2003021292) |
363L00000X Nurse Practitioner (Licence: WI 4021-33) | |
Enumeration Date | 2005-11-15 |
Last Update Date | 2023-08-24 |