| NPI | 1235310020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 78797) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 1495296-101) |
| Enumeration Date | 2007-11-20 |
| Last Update Date | 2021-03-11 |