NPI | 1114459005 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2018018402) |
Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS TMP-154470) |
Enumeration Date | 2017-03-30 |
Last Update Date | 2022-03-10 |