| NPI | 1275899908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2012039517) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 14-130969) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R 206502-7) | |
| 163W00000X Registered Nurse (Licence: MO 2013002145) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 43-557327) | |
| Enumeration Date | 2012-04-06 |
| Last Update Date | 2020-12-14 |