| NPI | 1548496714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 556905) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 1379895032) |
| Enumeration Date | 2009-06-02 |
| Last Update Date | 2011-10-12 |