| NPI | 1245459262 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: IL 041320404) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NE 65943) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NE 100989) | |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2007-07-24 |