NPI | 1164892469 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209.013330) |
Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: IL 209.013330) |
Enumeration Date | 2015-09-29 |
Last Update Date | 2020-08-12 |