| NPI | 1083172415 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2019017174) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D158561) |
| 163W00000X Registered Nurse (Licence: KS 14-121312-021) | |
| 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: KS 53-83869-021) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 43-557689-021) | |
| 363LP0200X Nurse Practitioner, Pediatrics (Licence: IA C183849) | |
| Enumeration Date | 2019-03-05 |
| Last Update Date | 2026-04-24 |