| NPI | 1720084080 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209020770) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 2133502) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2022-10-11 |