NPI | 1639286693 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 163W00000X Registered Nurse (Licence: AZ RN094653) |
Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AZ CRNA0231) |
Enumeration Date | 2006-08-24 |
Last Update Date | 2025-05-16 |