| NPI | 1376856369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 141608) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: KS 1395079022) |
| Enumeration Date | 2010-07-19 |
| Last Update Date | 2010-12-07 |