| NPI | 1962065060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 43-558163-011) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: KS 53-78636-011) |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2023-12-15 |