| NPI | 1548620016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1191178) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209013904) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: WI 8468-33) | |
| Enumeration Date | 2016-02-26 |
| Last Update Date | 2025-09-29 |