| NPI | 1053971903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 367500000X Nurse Anesthetist, Certified Registered (Licence: NJ 26NJ01250800) |
| Additional Taxonomies | 163WC0200X Registered Nurse, Critical Care Medicine (Licence: OH 427194) |
| Enumeration Date | 2019-06-13 |
| Last Update Date | 2022-07-26 |