| NPI | 1275900656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209013864) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 183149) |
| 163WC0200X Registered Nurse, Critical Care Medicine (Licence: TN 183149) | |
| Enumeration Date | 2015-09-01 |
| Last Update Date | 2020-10-01 |