| NPI | 1508338351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209019311) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 7117) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 041.429403) | |
| Enumeration Date | 2018-12-18 |
| Last Update Date | 2023-11-20 |