| 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 |