| NPI | 1679988968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209011712) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041359334) |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2026-01-15 |