| NPI | 1336545854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1138853) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.425396) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209.012327) | |
| Enumeration Date | 2014-11-11 |
| Last Update Date | 2024-05-06 |