| NPI | 1104506922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209028627) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.388548) |
| Enumeration Date | 2023-07-18 |
| Last Update Date | 2025-05-12 |