NPI | 1710631809 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11019592) |
Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: FL RN9401226) |
Enumeration Date | 2022-02-08 |
Last Update Date | 2022-05-20 |