| NPI | 1053974790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209019547) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041437410) |
| Enumeration Date | 2019-04-18 |
| Last Update Date | 2019-06-24 |