NPI | 1720519960 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2018028138) |
Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 43-557624) |
Enumeration Date | 2017-03-21 |
Last Update Date | 2020-01-22 |