| NPI | 1891986923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 55611) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 1497003081) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2016-01-07 |