| NPI | 1124655931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209.021621) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.375311) |
| Enumeration Date | 2020-03-24 |
| Last Update Date | 2025-05-08 |