| NPI | 1174269823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209.025389) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.375989) |
| Enumeration Date | 2022-05-06 |
| Last Update Date | 2024-06-26 |