NPI | 1720552789 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 11002413) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9327965) |
Enumeration Date | 2019-01-14 |
Last Update Date | 2019-05-13 |