| NPI | 1790039816 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MN 2216) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209009872) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IA D176311) | |
| Enumeration Date | 2012-10-29 |
| Last Update Date | 2023-10-25 |