| NPI | 1174943849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 43-557394-031) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2014018609) |
| 163W00000X Registered Nurse (Licence: MO 2006019444) | |
| Enumeration Date | 2014-04-22 |
| Last Update Date | 2026-04-21 |