| NPI | 1124268776 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0001209585) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 0001209585) |
| Enumeration Date | 2009-02-23 |
| Last Update Date | 2024-03-29 |