| NPI | 1639468796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 557016) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 88227) |
| 163W00000X Registered Nurse (Licence: MO 151646) | |
| Enumeration Date | 2011-03-29 |
| Last Update Date | 2014-02-20 |