| NPI | 1609405869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209021607) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041413905) |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2020-07-27 |