| NPI | 1962842427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2020016187) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 110659) |
| 163W00000X Registered Nurse (Licence: MO 2007034982) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 557179) | |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2024-01-04 |