| NPI | 1568893410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024194691) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041327984) |
| 207L00000X Anesthesiology (Licence: IL 209011253) | |
| Enumeration Date | 2013-12-03 |
| Last Update Date | 2025-12-10 |