| NPI | 1740552777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209009406) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041321295) |
| 163W00000X Registered Nurse (Licence: MO 2008036387) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2012004121) | |
| Enumeration Date | 2012-02-07 |
| Last Update Date | 2022-08-23 |