| NPI | 1649606351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MA RN2263334) |
| Additional Taxonomies | 363L00000X Nurse Practitioner (Licence: IL 209027184) |
| 363L00000X Nurse Practitioner (Licence: MA RN2263334) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 041414967) | |
| Enumeration Date | 2013-09-26 |
| Last Update Date | 2023-08-31 |