| NPI | 1487324919 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209024771) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 217833) |
| Enumeration Date | 2021-09-16 |
| Last Update Date | 2023-02-02 |