| NPI | 1265166904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 041478448) |
| Additional Taxonomies | 163WC0200X Registered Nurse Critical Care Medicine (Licence: IL 041.47844) |
| Enumeration Date | 2022-07-09 |
| Last Update Date | 2023-04-24 |