| NPI | 1356808869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 557719) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: FL 9440752) |
| 163W00000X Registered Nurse (Licence: KS 13124782052) | |
| Enumeration Date | 2019-02-21 |
| Last Update Date | 2019-09-13 |