NPI | 1164102026 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209030774) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041521509) |
Enumeration Date | 2023-07-24 |
Last Update Date | 2024-11-07 |