| NPI | 1174541700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 13-4819-111 035633) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 54983) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2015-07-08 |