| NPI | 1457879330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2023043288) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.453211) |
| 207L00000X Anesthesiology (Licence: IL 114630) | |
| Enumeration Date | 2017-08-31 |
| Last Update Date | 2024-02-29 |