| NPI | 1740668581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 557334) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 111327) |
| 163W00000X Registered Nurse (Licence: MO 2012010234) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2015018036) | |
| Enumeration Date | 2015-05-13 |
| Last Update Date | 2023-09-18 |