| 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: CO 1702126) |
| Enumeration Date | 2017-05-26 |
| Last Update Date | 2026-03-25 |