| NPI | 1518969526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 041128750) |
| Additional Taxonomies | 207L00000X Anesthesiology (Licence: IL 209.000126) |
| 207L00000X Anesthesiology (Licence: IL 041.128750) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: IL 209-000126) | |
| 207LP2900X Anesthesiology, Pain Medicine (Licence: IL 041-128750) | |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2018-08-27 |