| NPI | 1063842367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 557215) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2009029315) |
| 163W00000X Registered Nurse (Licence: KS 13109541081) | |
| Enumeration Date | 2013-11-22 |
| Last Update Date | 2014-03-03 |