| NPI | 1619917846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 55010) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN R173062-5) |
| 163W00000X Registered Nurse (Licence: KS 64649) | |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2026-02-11 |