| NPI | 1487061636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367H00000X Anesthesiologist Assistant (Licence: IL 2090121874) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL ARNP9296749) |
| Enumeration Date | 2014-07-21 |
| Last Update Date | 2015-01-08 |