| NPI | 1376506147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 55477) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 13-78804-072) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2022-09-15 |