NPI | 1770729469 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 209007476) |
Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041335503) |
Enumeration Date | 2008-12-30 |
Last Update Date | 2015-01-20 |