| NPI | 1861900490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209028326) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: VA 0024175735) |
| Enumeration Date | 2018-01-17 |
| Last Update Date | 2023-11-13 |