| NPI | 1124211792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 55620) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 1390042011) |
| Enumeration Date | 2007-08-27 |
| Last Update Date | 2008-08-08 |