| NPI | 1700176641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 43-557014-042) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2008005179) |
| 163W00000X Registered Nurse (Licence: KS 13-995757-042) | |
| Enumeration Date | 2011-04-12 |
| Last Update Date | 2024-08-01 |