NPI | 1639160674 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 036799) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: KY 1041947) |
Enumeration Date | 2005-10-31 |
Last Update Date | 2012-08-28 |