| NPI | 1396003158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 557082) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IA 117147) |
| 163W00000X Registered Nurse (Licence: KS 14107434031) | |
| 163W00000X Registered Nurse (Licence: OK 101578) | |
| Enumeration Date | 2012-04-30 |
| Last Update Date | 2021-03-04 |