| NPI | 1306384995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209022633) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 232150-30) |
| Enumeration Date | 2017-02-03 |
| Last Update Date | 2022-10-24 |