| NPI | 1114064524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209.010243) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.408578) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2019-04-11 |