| NPI | 1396197232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2016032670) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2010023164) |
| 163W00000X Registered Nurse (Licence: KS 14-121072-031) | |
| Enumeration Date | 2016-07-03 |
| Last Update Date | 2022-05-08 |