| NPI | 1700774734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209033305) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95002704) |
| 163W00000X Registered Nurse (Licence: CA 95196322) | |
| Enumeration Date | 2025-06-26 |
| Last Update Date | 2025-09-24 |