| NPI | 1114553880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209024260) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 6323) |
| Enumeration Date | 2020-03-13 |
| Last Update Date | 2021-11-29 |