NPI | 1871124552 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 3018869) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN9525637) |
Enumeration Date | 2020-01-30 |
Last Update Date | 2023-12-19 |