| NPI | 1972875458 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2015013657) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2015013657) |
| 163W00000X Registered Nurse (Licence: KS 13-131020-081) | |
| Enumeration Date | 2012-01-31 |
| Last Update Date | 2020-06-09 |