| NPI | 1083066773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2016033628) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2012022543) |
| 163W00000X Registered Nurse (Licence: KS 14-127117-072) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 43-557438) | |
| Enumeration Date | 2016-07-06 |
| Last Update Date | 2016-09-20 |