| NPI | 1770207532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209.026717) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.436098) |
| Enumeration Date | 2022-09-26 |
| Last Update Date | 2023-01-18 |