NPI | 1689104499 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R195987) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: MD R195987) |
363LF0000X Nurse Practitioner, Family (Licence: MD R195987) | |
Enumeration Date | 2017-06-14 |
Last Update Date | 2023-09-18 |