| NPI | 1003438599 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NJ01048400) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NJ 26NR19622700) |
| Enumeration Date | 2020-05-07 |
| Last Update Date | 2020-11-05 |