| NPI | 1396219176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209018755) |
| Additional Taxonomies | 163WF0300X Registered Nurse, Flight (Licence: IL 041423146) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95001137) | |
| Enumeration Date | 2019-01-15 |
| Last Update Date | 2019-08-04 |