| NPI | 1386916088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS TMP 144235) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 708138) |
| 163W00000X Registered Nurse (Licence: KS 14-117691-111) | |
| Enumeration Date | 2012-01-27 |
| Last Update Date | 2012-03-07 |