| NPI | 1093241135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 557503) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 109113) |
| Enumeration Date | 2017-05-10 |
| Last Update Date | 2026-05-30 |