| NPI | 1477372407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209030795) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209.030795) | |
| Enumeration Date | 2024-10-07 |
| Last Update Date | 2024-10-22 |