| NPI | 1285308171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209.024656) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: TN 234503) |
| Enumeration Date | 2021-08-04 |
| Last Update Date | 2022-05-26 |