| NPI | 1659981017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 557837) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 135451) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KS TMP159804) | |
| Enumeration Date | 2020-07-31 |
| Last Update Date | 2022-01-18 |