| NPI | 1720678022 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1028724) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 041418380) |
| Enumeration Date | 2021-01-20 |
| Last Update Date | 2022-07-22 |