| NPI | 1124574454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 557462) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO 0993558) |
| Enumeration Date | 2016-08-28 |
| Last Update Date | 2018-05-07 |