NPI | 1679009179 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN9339370) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9339370) |
Enumeration Date | 2017-05-04 |
Last Update Date | 2023-01-26 |