| NPI | 1720592595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: CA 950001442) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.458698) |
| Enumeration Date | 2017-11-30 |
| Last Update Date | 2021-05-14 |