| NPI | 1982251054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209023941) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: WI 173309) |
| 207L00000X Anesthesiology (Licence: IL 209023941) | |
| Enumeration Date | 2019-08-22 |
| Last Update Date | 2022-06-01 |