| NPI | 1770956690 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209013610) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041389755) |
| 163W00000X Registered Nurse (Licence: IN 28204790A) | |
| Enumeration Date | 2015-11-02 |
| Last Update Date | 2015-11-22 |