| NPI | 1255077608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 558027) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 13110138072) |
| Enumeration Date | 2022-05-09 |
| Last Update Date | 2022-09-21 |