| NPI | 1255799391 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209.013804) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.384446) |
| Enumeration Date | 2016-02-03 |
| Last Update Date | 2018-05-24 |