| NPI | 1114459005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2018018402) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS TMP-154470) |
| Enumeration Date | 2017-03-30 |
| Last Update Date | 2022-03-10 |