| NPI | 1902445513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 95001590) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 041-451704) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209020793) | |
| Enumeration Date | 2019-12-30 |
| Last Update Date | 2022-09-29 |