| NPI | 1780001461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209014226) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PR 101275) |
| Enumeration Date | 2014-03-19 |
| Last Update Date | 2016-04-08 |