| NPI | 1174064935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 43-557515) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2014006444) |
| 163W00000X Registered Nurse (Licence: KS 13-98792-091) | |
| Enumeration Date | 2017-03-13 |
| Last Update Date | 2017-08-09 |