| NPI | 1467975441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS TMP155006) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS TMP-155002) |
| 163WC0200X Registered Nurse Critical Care Medicine (Licence: MO 2011000224) | |
| Enumeration Date | 2017-07-20 |
| Last Update Date | 2017-07-24 |