| NPI | 1457467060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 54412) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 069074) |
| 163W00000X Registered Nurse (Licence: KS 45701) | |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2014-03-07 |