| NPI | 1194306456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 557935) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 13136799062) |
| Enumeration Date | 2021-04-19 |
| Last Update Date | 2021-11-10 |