| NPI | 1356310825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209007031) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: KS 55377) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: KS 55377) | |
| Enumeration Date | 2006-03-16 |
| Last Update Date | 2025-04-10 |