| NPI | 1588651566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209005907) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MD R143228) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2019-06-13 |