| NPI | 1871579433 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 55041) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 81253) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2013-07-31 |