| NPI | 1194016873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C003101) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 114483) |
| 163W00000X Registered Nurse (Licence: AR R099068) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 143005) | |
| Enumeration Date | 2011-04-28 |
| Last Update Date | 2021-06-18 |