| NPI | 1053826552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 43-557560-051) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 13-113880-051) |
| Enumeration Date | 2017-12-06 |
| Last Update Date | 2017-12-29 |