| NPI | 1649541848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 557058) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 13-92870) |
| Enumeration Date | 2012-01-19 |
| Last Update Date | 2012-02-15 |