| NPI | 1912361163 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2016019123) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 43-557426-091) |
| 163W00000X Registered Nurse (Licence: MO 2009030213) | |
| Enumeration Date | 2016-04-13 |
| Last Update Date | 2023-06-07 |