NPI | 1962467472 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2019017345) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2015001767) |
163W00000X Registered Nurse (Licence: KS 14-133862) | |
Enumeration Date | 2006-04-18 |
Last Update Date | 2019-05-30 |