| NPI | 1265829113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209.012934) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041382727) |
| 163W00000X Registered Nurse (Licence: WI 193394) | |
| Enumeration Date | 2015-04-17 |
| Last Update Date | 2015-08-14 |