| NPI | 1548443146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209011241) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: MO 2002014595) |
| 363LP0222X Nurse Practitioner, Pediatrics, Critical Care (Licence: MO 20071425) | |
| Enumeration Date | 2007-12-06 |
| Last Update Date | 2016-10-31 |