| NPI | 1871245340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 557984) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 135769) |
| Enumeration Date | 2022-01-25 |
| Last Update Date | 2022-06-16 |