| NPI | 1528797008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2022020574) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2012017500) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 43-558209-081) | |
| Enumeration Date | 2022-06-09 |
| Last Update Date | 2026-04-24 |