| NPI | 1609252642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209026451) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2015025687) |
| Enumeration Date | 2015-07-31 |
| Last Update Date | 2023-04-19 |