NPI | 1780359521 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D165062) |
Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: ND R32399) |
Enumeration Date | 2021-08-13 |
Last Update Date | 2024-09-04 |