| NPI | 1063931038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207L00000X Anesthesiology (Licence: NJ 26NJ15236100) |
| Additional Taxonomies | 367500000X Nurse Anesthetist, Certified Registered (Licence: OH CRNA019574) |
| 367500000X Nurse Anesthetist, Certified Registered (Licence: OH LE-00020509) | |
| Enumeration Date | 2017-09-11 |
| Last Update Date | 2025-04-29 |