| NPI | 1326581133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 557461) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 113-89952-032) |
| Enumeration Date | 2016-11-28 |
| Last Update Date | 2019-04-02 |