| NPI | 1124109517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 55160) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 4355160) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2020-09-24 |