| NPI | 1568851194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209-017203) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 105461) |
| Enumeration Date | 2015-01-20 |
| Last Update Date | 2024-02-08 |