| NPI | 1053854901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 43-557464) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: VA 0001252011) |
| 163W00000X Registered Nurse (Licence: KS 14-138111) | |
| Enumeration Date | 2016-11-27 |
| Last Update Date | 2017-02-02 |