| NPI | 1699229369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209014801) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041305001) |
| 163W00000X Registered Nurse (Licence: WI 142768-30) | |
| Enumeration Date | 2016-08-10 |
| Last Update Date | 2016-10-14 |