| NPI | 1700362183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NM 55422) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041465807) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 120003) | |
| Enumeration Date | 2018-07-18 |
| Last Update Date | 2024-04-03 |