| NPI | 1790764686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209002590) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 132185) |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2022-01-06 |