| NPI | 1326345943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209009746) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MO 2007002239) |
| 163W00000X Registered Nurse (Licence: IL 041.355743) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 20110007025) | |
| Enumeration Date | 2011-02-16 |
| Last Update Date | 2024-12-11 |