NPI | 1487630091 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 037860) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1054975) |
Enumeration Date | 2005-12-16 |
Last Update Date | 2008-04-20 |