| NPI | 1255591178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 43-557012) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 20000151371) |
| Enumeration Date | 2008-06-13 |
| Last Update Date | 2026-04-08 |