| NPI | 1427936830 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 43-558394-122) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 13-147255-122) |
| Enumeration Date | 2025-08-25 |
| Last Update Date | 2026-07-20 |