| NPI | 1598187221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209011259) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: CA 774219) |
| 163W00000X Registered Nurse (Licence: IL 041418021) | |
| Enumeration Date | 2014-01-15 |
| Last Update Date | 2022-01-03 |