| NPI | 1821546938 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209015301) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.382319) |
| Enumeration Date | 2016-09-18 |
| Last Update Date | 2017-02-16 |