| NPI | 1902578792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: IL 1902578792) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: IL 041.456123) |
| Enumeration Date | 2021-09-30 |
| Last Update Date | 2023-04-11 |