| NPI | 1073594461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 041-232449) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209-003657 APN licen) |
| Enumeration Date | 2005-11-11 |
| Last Update Date | 2010-09-01 |