| NPI | 1760628457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209007475) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041311481) |
| Enumeration Date | 2008-12-30 |
| Last Update Date | 2009-02-05 |