| NPI | 1013156926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 257568) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: IL 041-302032) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: FL 9291172) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209-008050) | |
| Enumeration Date | 2009-02-17 |
| Last Update Date | 2025-03-04 |