| NPI | 1205391620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95001930) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IL 209018750) |
| Enumeration Date | 2019-02-11 |
| Last Update Date | 2023-06-21 |