| NPI | 1376512996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 43-54349-022) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 114823) |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2014-07-29 |