| NPI | 1235719162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 135145) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041439189) |
| Enumeration Date | 2021-04-13 |
| Last Update Date | 2021-06-05 |