NPI | 1124799655 |
---|---|
Former Name | AMALIE SMITH |
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209027680) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041400420) |
163W00000X Registered Nurse (Licence: WI 25878830) | |
Enumeration Date | 2021-09-23 |
Last Update Date | 2023-06-16 |