| NPI | 1902478985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 43-558024) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MI 4704357975) |
| Enumeration Date | 2021-07-11 |
| Last Update Date | 2023-02-09 |