| NPI | 1093351926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209-020553) |
| Additional Taxonomies | 364S00000X Clinical Nurse Specialist (Licence: IL 209-020553) |
| 163W00000X Registered Nurse (Licence: IL 041399866) | |
| Enumeration Date | 2019-11-26 |
| Last Update Date | 2026-02-03 |