| NPI | 1386627388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 55144) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 1492371111) |
| 163W00000X Registered Nurse (Licence: MO 111099) | |
| 363L00000X Nurse Practitioner (Licence: KS 55144) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 111099) | |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2008-10-20 |