NPI | 1629861869 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11039891) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9469146) |
367500000X Nurse Anesthetist, Certified Registered (Licence: FL 154777) | |
Enumeration Date | 2025-05-28 |
Last Update Date | 2025-08-18 |