| NPI | 1891792008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 54941) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CO CRA-100034) |
| Enumeration Date | 2005-07-01 |
| Last Update Date | 2022-10-31 |