| NPI | 1417579368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 43-557795-102) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2020014043) |
| 163W00000X Registered Nurse (Licence: SD R046087) | |
| Enumeration Date | 2020-05-14 |
| Last Update Date | 2026-04-08 |