| NPI | 1811300718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 041.420223) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: AR C003044) |
| Enumeration Date | 2014-06-09 |
| Last Update Date | 2017-01-03 |