NPI | 1780223818 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL APRN11005952) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9320977) |
Enumeration Date | 2020-01-07 |
Last Update Date | 2021-07-19 |