| NPI | 1740479989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209003210) |
| Additional Taxonomies | 367H00000X Anesthesiologist Assistant (Licence: IL 209009210) |
| Enumeration Date | 2007-10-23 |
| Last Update Date | 2013-02-18 |