| NPI | 1619562584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209023442) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041460929) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: MO 2021040417) | |
| Enumeration Date | 2021-03-03 |
| Last Update Date | 2024-04-16 |