| NPI | 1205838216 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209.000856) |
| Additional Taxonomies | 207LP2900X Anesthesiology, Pain Medicine (Licence: IL 041-144402) |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: IL 209-000856) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 041.144402) | |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2010-06-11 |