| NPI | 1215202197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS TMP144722) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL RN 9288567) |
| Enumeration Date | 2012-03-12 |
| Last Update Date | 2012-06-02 |