NPI | 1619636883 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11030608) |
Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D184978) |
Enumeration Date | 2021-12-14 |
Last Update Date | 2025-07-08 |