| NPI | 1770998924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209011621) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2014013826) |
| Enumeration Date | 2014-06-26 |
| Last Update Date | 2021-12-28 |