| NPI | 1780640698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209-003040) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041250380) |
| 163W00000X Registered Nurse (Licence: WI 119308030) | |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2007-07-08 |