| NPI | 1700500824 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209.026641) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NM R64067) |
| Enumeration Date | 2022-10-03 |
| Last Update Date | 2022-12-27 |