| NPI | 1306149554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209.019297) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.478201) |
| 163W00000X Registered Nurse (Licence: NC 223941) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NC 223941) | |
| Enumeration Date | 2010-12-09 |
| Last Update Date | 2019-05-22 |