NPI | 1902478985 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 43-558024) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704357975) |
Enumeration Date | 2021-07-11 |
Last Update Date | 2023-02-09 |