| NPI | 1376545160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209002136) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: IL 041-255087) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: IL 209-002136) | |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2025-12-16 |