| NPI | 1740895218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MI 4704294984) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.495018) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209021996) | |
| Enumeration Date | 2020-09-11 |
| Last Update Date | 2023-12-29 |