NPI | 1083172415 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 557689) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 121312) |
Enumeration Date | 2019-03-05 |
Last Update Date | 2023-12-14 |