| NPI | 1164911285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: ID 65445) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 13-121632-081) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 43-557602-081) | |
| Enumeration Date | 2018-05-03 |
| Last Update Date | 2020-10-14 |