| NPI | 1023263373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NY 686536) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: NJ 26NR17625800) |
| 235Z00000X Speech-Language Pathologist, (Licence: NY 58017722) | |
| 235Z00000X Speech-Language Pathologist, (Licence: NJ 41ys00574800) | |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NJ01180100) | |
| Enumeration Date | 2008-11-27 |
| Last Update Date | 2024-09-01 |