| NPI | 1528092152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MT NUR-APRN-LIC-101043) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: MT NUR-RN-LIC-39555) |
| 163W00000X Registered Nurse (Licence: IL 041-229950) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209-001379) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2022-05-02 |