| NPI | 1447790944 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 43557504111) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2011018778) |
| 163W00000X Registered Nurse (Licence: KS 14139203111) | |
| Enumeration Date | 2017-03-02 |
| Last Update Date | 2017-07-13 |