| NPI | 1306562772 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209026206) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041472221) |
| Enumeration Date | 2022-10-17 |
| Last Update Date | 2026-02-26 |