| NPI | 1780299362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209-024827) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: PA RN705926) |
| 163W00000X Registered Nurse (Licence: NY 697199) | |
| Enumeration Date | 2020-09-10 |
| Last Update Date | 2023-12-10 |