| NPI | 1659095958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 558042) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 147049) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OK 222401) | |
| Enumeration Date | 2022-09-29 |
| Last Update Date | 2025-03-24 |