| NPI | 1376933374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: UT 6672876-4406) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 130234) |
| 163W00000X Registered Nurse (Licence: UT 6672876-3102) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 557320) | |
| Enumeration Date | 2015-01-28 |
| Last Update Date | 2021-10-26 |