| NPI | 1528111432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IN 28121156A) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041-284285) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209-004259) | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2023-11-27 |