| NPI | 1033670187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2022017635) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209019865) |
| 163WS0200X Registered Nurse, School (Licence: IL 041441499) | |
| Enumeration Date | 2019-03-29 |
| Last Update Date | 2025-12-16 |