| NPI | 1306339247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209031872) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 041581166) |
| Enumeration Date | 2018-06-14 |
| Last Update Date | 2025-09-09 |