| NPI | 1518371640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 557297) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 13106701012) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 149632) | |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2014-10-21 |