| NPI | 1912356494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 041.442743) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 186574) |
| 163W00000X Registered Nurse (Licence: IL 209.014949) | |
| Enumeration Date | 2016-06-06 |
| Last Update Date | 2018-12-19 |