| NPI | 1629506258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 43-558362) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN590684) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CO APN.1000833-CRNA) | |
| Enumeration Date | 2017-05-26 |
| Last Update Date | 2025-12-31 |