| NPI | 1306847678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 55039) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 153804) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2025-09-22 |