NPI | 1821509753 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 557524) |
Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D170072) |
Enumeration Date | 2017-10-18 |
Last Update Date | 2025-07-15 |