| NPI | 1649241563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 163W00000X Registered Nurse (Licence: IL 041230737) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209001243) |
| 163W00000X Registered Nurse (Licence: IN 28122178A) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2007-07-08 |