| NPI | 1255060687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 43558040102) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: KS 99751) |
| 207L00000X Anesthesiology (Licence: KS 43-558040-102) | |
| Enumeration Date | 2022-06-09 |
| Last Update Date | 2023-05-08 |