| NPI | 1811374762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2015018027) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 43-557714-081) |
| 163W00000X Registered Nurse (Licence: MO 2010036177) | |
| Enumeration Date | 2015-04-29 |
| Last Update Date | 2025-05-02 |