| NPI | 1891107652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2016015976) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 114826) |
| 163W00000X Registered Nurse (Licence: MO 2011013251) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 557258) | |
| Enumeration Date | 2014-05-28 |
| Last Update Date | 2019-08-20 |