| NPI | 1770095960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209016798) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041386192) |
| Enumeration Date | 2017-10-29 |
| Last Update Date | 2017-10-29 |