| NPI | 1013470335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM 61518) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 13-127191-022) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 557731) | |
| Enumeration Date | 2019-04-12 |
| Last Update Date | 2020-11-04 |