| NPI | 1194733394 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 55484) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 14-90966-052) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2020-02-03 |