NPI | 1487650115 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 4120A) |
Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 470417018) |
Enumeration Date | 2005-06-27 |
Last Update Date | 2012-08-07 |