| NPI | 1194104554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 557374) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 103574) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KS TMP-151969) | |
| Enumeration Date | 2015-05-19 |
| Last Update Date | 2015-10-13 |