| NPI | 1215281548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 557157) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA 618172) |
| Enumeration Date | 2012-11-08 |
| Last Update Date | 2021-09-08 |