| NPI | 1225308281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209011564) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 184225-30) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KY 1120847) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 5118-33) | |
| Enumeration Date | 2012-01-09 |
| Last Update Date | 2022-10-13 |