NPI | 1154492767 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 54172) |
Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 087070) |
163W00000X Registered Nurse (Licence: NY 678430) | |
Enumeration Date | 2006-11-13 |
Last Update Date | 2015-03-16 |