| NPI | 1780279323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209023545) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: HI APRN-5299) |
| Enumeration Date | 2021-03-05 |
| Last Update Date | 2026-07-07 |