| NPI | 1407099328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209007714) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041-344775) |
| Enumeration Date | 2009-04-07 |
| Last Update Date | 2010-08-04 |