| NPI | 1861841462 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 557442) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 278235) |
| 163W00000X Registered Nurse (Licence: KS 137240) | |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2016-09-19 |