NPI | 1720036882 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209003942) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041301998) |
Enumeration Date | 2006-05-04 |
Last Update Date | 2017-05-09 |