| NPI | 1477632123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 55371) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 144284) |
| 163W00000X Registered Nurse (Licence: KS 1375832091) | |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2022-10-13 |