| NPI | 1134119969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209023100) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 117031) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2024-11-12 |