| NPI | 1215505540 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 557908) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 13139721051) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 30904) | |
| Enumeration Date | 2021-06-14 |
| Last Update Date | 2022-07-26 |