| NPI | 1790350999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 557880) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 131423) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2022033814) | |
| Enumeration Date | 2021-05-21 |
| Last Update Date | 2023-05-31 |