| NPI | 1235779935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 125560) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041440484) |
| Enumeration Date | 2020-01-10 |
| Last Update Date | 2020-04-09 |