NPI | 1609265065 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NH 074985-23) |
Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: GA 281215) |
367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP9178468) | |
363LF0000X Nurse Practitioner, Family (Licence: FL 2017019797) | |
Enumeration Date | 2015-01-22 |
Last Update Date | 2020-05-17 |