| NPI | 1487989083 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209007843) |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2009-10-15 |
| Last Update Date | 2017-12-15 |