| NPI | 1497295901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: TX 1113831) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209016165) |
| 163W00000X Registered Nurse (Licence: IL 041.449328) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 857695) | |
| Enumeration Date | 2017-03-02 |
| Last Update Date | 2025-10-09 |