NPI | 1366830432 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209012356) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041368366) |
Enumeration Date | 2014-12-24 |
Last Update Date | 2022-08-30 |