| NPI | 1669750386 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 557048) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 1390058032) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KS TMP143428) | |
| Enumeration Date | 2011-07-29 |
| Last Update Date | 2022-01-13 |