| NPI | 1215113915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 43-557061-102) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2015027896) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 2015027896) | |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2025-07-09 |