| NPI | 1497080865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TN 23266) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041354280) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209007884) | |
| Enumeration Date | 2009-10-02 |
| Last Update Date | 2018-04-02 |