| NPI | 1922882356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209032462) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: IL 041.496361) |
| Enumeration Date | 2023-08-24 |
| Last Update Date | 2025-06-06 |