| NPI | 1083627012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 074718) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NC 207931) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2012-07-10 |