NPI | 1720497498 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209.011684) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041419325) |
Enumeration Date | 2014-08-07 |
Last Update Date | 2017-03-30 |