| NPI | 1407479900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 43-557773-102) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 13-127092-102) |
| Enumeration Date | 2020-05-19 |
| Last Update Date | 2020-06-24 |