| NPI | 1326096702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 193568) |
| Additional Taxonomies | 174400000X Specialist (Licence: IL 209003966) |
| 174400000X Specialist (Licence: IN 28094020A) | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2022-11-09 |