| NPI | 1356781116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 557203) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 147494) |
| 163W00000X Registered Nurse (Licence: KS 100045) | |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2014-01-15 |